Some 1,400 people across the state of North Carolina may lose housing as a result of funding cuts. As of Jan. 1, the state has begun to implement new Personal Care Service guidelines that must be met in order for those who suffer from mental disabilities and reside in group homes to continue qualifying for Medicaid-funded housing.
Group home residents are increasingly being denied Medicaid payments for Personal Care Services (PCS), a program that is a Medicaid State Plan benefit designed to care for individuals residing in private living arrangements, or at residential facility licensed by the State of North Carolina as an adult care home, or a combination home as defined in General Statute 131E-101(1a.). These services are available to individuals who have a medical condition, disability, or cognitive impairment that demonstrates unmet needs for, at a minimum three of five qualifying activities of daily living such as eating, dressing, bathing, toileting and mobility.
According to Denise Coleman of North Carolina ARC (Association of Retarded Citizens) in Haywood County, the changes are a result of revisions to Clinical Coverage Policy 3L which defined the care that can be provided in a much more limited way. “Our group homes are always working with the individuals and prompting them to complete as much of their self care as possible to create greater independence and dignity. This policy makes funding only available if the person requires “hands-on” assistance,” said Coleman.
The changes were mandated by federal regulations that were established in order to ensure that eligibility criteria was universal for everyone, no matter if a person lived at home, a group home, or a larger treatment facility. But to have a set criteria for each circumstance is illegal under federal Medicaid law. The North Carolina General Assembly developed a new set of guidelines that would be used for all arrangements. The guidelines that were established required recipients receiving PCS Medicaid payments to meet three out of the five qualifying activities of daily living.
“People with mental disabilities often do not meet these new guidelines because they know how to dress themselves, bathe, toilet, etc.,” said Deby Dihoff, executive director of NAMI North Carolina (National Alliance on Mental Illness). “Yet they need a structured group home and the group home relies on that funding source just to pay for operating expenses.”
The average six-bed group home will lose approximately $36,000 per year in funding that they require in order to stay operational. In a recent survey conducted by the organization, most group homes across the state showed concern of only being able to remain open for a few months if this issue is not rectified.
According to Dihoff, a state funded program would be the best option in regards to the issue. “They probably should have never looked to Medicaid for these services. [Medicaid] is really for rehabilitation, medical interventions, and treatments. Some of that is really just giving people a helping hand at times. They got into trouble with the definition. They never funded these people and now it has caught up with them.”
On Jan. 31, the North Carolina House of Representatives unanimously passed House Bill 5: Temporary Funding Extension for Group Homes, a bill that requires the U.S. Department of Health and Human Services to provide temporary funding to residents living at group homes across the state who have lost their Medicaid eligibility of personal care services.
The bill would allow group home operators to dip into a fund of $39.7 million which was set aside in last summer's budget to help adult care homes transition to new Medicaid eligibility requirements regarding personal care services, but due to the language used in the budget, group homes, which usually house up to ten individuals did not qualify for the money.
“This is not new money, it had already been set aside, we just had to get that money in play before those people ran into a problem and were kicked out of their homes,” said Rep. Roger West. “We put a temporary fix on it with that money until June 30, and there's going to be some legislation come out of this session that will hopefully put a fix on it.”
Since group homes are not allowed to use these funds as of yet, former Gov. Bev Purdue set aside $1 million that helped them through the month of January, in hopes that lawmakers would be able to correct the situation.
As a result of House Bill 5, DHHS could pay up to $694 a month per resident who becomes ineligible for Medicaid-covered personal care services for a period not to exceed three months. After the initial three months, the monthly payment for each resident will be reduced by 25 percent. These payments are only made from the date that the bill is passed through June 30, or until the funds are depleted.
A short term solution is necessary, but a long term solution must be established between now and June 30, when the funding is set to expire according to House Bill 5. Dihoff and NAMI suggest the development of a new definition that those suffering from mental disabilities would fall under new operating strategies for the group homes as well.
“I think we also need to look at the service definition for group homes. They need to be more recovery oriented. A lot of times they end up being a warehouse for people,” suggests Dihoff, “They move in, they get comfortable, the provider gets comfortable with their five people. Often times there are these perverse effects. It's easier for those group homes to keep the people they've got so we need to be more diligent to move people through that service during the time they need it. The clients receiving the services should be involved in their decision making. There should be empowerment in their recovery and those that can progress should be successfully discharged into an arrangement that is more independent.”
The bill now moves to the Senate floor where at one time, the serving members did not seem to approach the bill with the urgency that the House showed, but Rep. West believes that the bill will move forward, “I haven't looked at their calendar, but I'm sure they're going to take it up this week and send it on out of there,” said West, “I hope they do anyway, I can't foresee them not doing it.”
Senator Davis shared Rep. West's sentiment, “I anticipate that it will come before the Senate this week,” said Davis. “And that's a good thing. I will tell you that I think it is a good investment, those group homes, they do a lot of good and it's certainly a priority of mine.”